Transcript Deborah-Black-1330

Cities, environmental stressors,
ageing and chronic disease
FACULTY OF
HEALTH SCIENCES
PROFESSOR DEBORAH BLACK
OVERVIEW
› Why do environmental stressors impact more on the
ageing?
› Is it more of a problem in cities?
› Extreme heat and aged care facilities
› Activities - How can practitioners respond to these
two major issues facing developed countries?
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What is ageing and what is the impact of environmental
stressors?
› “Ageing is usually defined as the progressive loses of biological function
accompanied by decreasing fertility and increasing mortality with
advancing age. This process usually occurs after sexual maturation and
continues up to the time of maximum longevity (life span) for members of a
species. Death is the final event. Roughly speaking life span of an
organism is proportional to its size -- bacteria may only live for a few
hours, an insect a few days, and an elephant for years” (accessed 23
September, 2013 http://universe-review.ca/R10-27-ageing.htm)
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Life Span
http://universe-review.ca/R10-27-ageing.htm
Environmental
stressors
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Exposure to Environmental stressors
› Exposure is contact between the environmental agent and an individual
› Exposure is measured as the product of concentration to environmental
stressors eg noise, air pollution (DOSE) and the length of time the
individual has been exposed (TIME)
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Geller A & Zenick H (2005) Aging and the environment: A research
framework Environmental Health Perspectives 113:9; 1257-1262
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Ageing Population
• diminished thermoregulation
•Diminished physiologic heat-adaption
•Live alone
•Reduced social contact
•Chronic health issues
Australian Health
System in 20 years
› The Intergovernmental Panel on Climate Change (IPCC, 2007)
concluded:
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Human beings are exposed to climate change through changing
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weather
patterns (for example, more intense and frequent extreme
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events) and Bindirectly
in water,
air,Rfood quality and
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F through changes
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quantity, ecosystems,
agriculture,
and
economy.
At this
early stage the
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effects are small
but
increase in all
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countries
and
regions.
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Population Pyramid
› http://www.abs.gov.au/websitedbs/d3310114.nsf/home/Population%20Pyramid%20-%20Australia
› POPULATION AGEING
The ageing of Australia's population, already evident in the current age structure, is expected to continue.
This is the result of sustained low levels of fertility combined with increasing life expectancy at birth. The
median age of Australia's population (36.8 years at 30 June 2007) is projected to increase to between 38.7
years and 40.7 years in 2026 (Series A and C respectively) and to between 41.9 years and 45.2 years in
2056 (Series A and C).
The age composition of Australia's population is projected to change considerably as a result of population
ageing. By 2056 there will be a greater proportion of people aged 65 years and over than at 30 June 2007,
and a lower proportion of people aged under 15 years. In 2007 people aged 65 years and over made up
13% of Australia's population. This proportion is projected to increase to between 23% and 25% in 2056
(Series B and C respectively) and to between 25% and 28% in 2101 (Series B and C). The proportion of
people aged under 15 years is projected to decrease from 19% in 2007 to between 15% and 18% in 2056
(Series C and A respectively) and to between 14% and 17% in 2101 (Series C and A).
There were 344,100 people aged 85 years and over in Australia at 30 June 2007, making up 1.6% of the
population. This group is projected to grow rapidly throughout the projection period, to between 4.9% and
7.3% by 2056 (Series B and A respectively), and to between 5.8% and 9.3% by 2101 (Series B and A).
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Population projections
›In 2009, around 15% of the population
in Australia was aged 65+ years
›In 2026, this will rise to around 22%
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Environmental Climate Change
› "If we reach a figure of carbon dioxide concentrations in the atmosphere of
440 parts per million (ppm), we reach what's called "the tipping point" .
› After that we're into totally unknown territory. There is a step-change in the
way climate change will work... now at the moment we're up to 382 ppm
pushing on 383. T
› he concentration is increasing by about 2 to 3 ppm a year, so we're going
get to that 440 relatively soon. We've got perhaps 20 years before we
really do start to face potentially catastrophic consequences.
› "Prof. Peter F. Smith on renewables and climate change (1 Sept, 2006)
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Climate change and health
Climate Change and Health (McMichael et al 2008)
› Human actions are changing many of the world’s natural environmental
systems, including the climate system. These systems are intrinsic to life
processes and fundamental to human health, and their disruption and
depletion make it more difficult to tackle health inequalities. Indeed, we will
not achieve the UN millennium development health goals if environmental
destruction continues.1 Health professionals have a vital contributory role
in preventing and reducing the health effects of global environmental
change.
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Sustainable solutions
Black D & Black J Int. J. Environ. Res. Public Health 2009, 6, 1557-1596
› A complete understanding of this dimension of human health
requires knowledge about the effects of global economic and
climate change on: ecosystem sustainability and on human
health; on the effects of pollutants within human communities;
on the interaction between environment, development, and
human health; and on the management of solutions to these
challenges across local, regional, and global scales.
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Faculty research
Does living in cities long term expose the
ageing to increased prevalence of chronic
disease?
Black, DA., Kendig, H., O’Loughlin, K., Wilson, LA. Cities,
Environmental Stressors, Ageing and Chronic Disease (2011)
Australasian Journal on Ageing (Sept, 2011 – in press)
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Locality based analysis
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Study overview
›WHY did we do the study?
›WHO were selected?
›HOW did we undertake study?
›WHAT did we find?
›So WHAT?
›WHERE to next?
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Aim
The aim was to examine the
relationship between long-term
exposure to environmental stressors of
ageing, urban-based Australians and
incidence of non-infectious chronic
diseases.
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Why?
› The population of Australia is ageing
› The ageing population is more likely to live in cities
› The burden of chronic disease is increasing as the
population ages
› Urban exposure to noise, air pollution and pesticides
is known to increase the likelihood of specific chronic
diseases
› Forms part of a sub-study of ABBA ARC Linkage
grant
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Urbanisation
While Australia is double the size of Europe, three-quarters of the
country is sparsely populated countryside or harsh outback, leaving
the bulk of the population to inhabit a thin strip down the southeast
coast. In fact, around 50 percent of the population live in the three
largest cities -- Sydney, Melbourne and Brisbane -- on a combined
land area that is about the size of Brunei or Trinidad & Tobago.
Michael Perry, Reuters March 15, 2010
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Population Density in Australia, 2012
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Who?
› A cohort of 1312 participants from the
Household Income and Labour
Dynamics in Australia (HILDA) Survey
› All were aged over 45 years and
interviewed at baseline (Wave1 2001)
› Lived in the same location for at least 20
years
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How ?
Arthritis
Depression/anxiety
Asthma
Heart/coronary disease
Any type of cancer
High blood pressure/hypertension
Chronic bronchitis or
emphysema
Other circulatory conditions
Type 2 diabetes (adult
onset)
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How?
› Logistic regression was undertaken with the
presence of at least one long-term health
condition as the outcome variable.
› Covariates were age, gender, geographic area
and socio-economic status (SEIFA)
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What?
• increasing age
• being male
• living in a major city or
inner urban area, and
• living in an area with a
lower socio-economic
status
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What?
Findings from our research
› Our study of ageing Australians
reinforces the association between longterm exposure to environmental stressors
such as air pollution and noise in large
cities and developing long-term health
conditions.
› The analysis at baseline demonstrated
that older urban and city dwellers were
more likely to have one or more longterm health conditions.
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So what?
› The paucity of literature into the effects of
environmental exposure on the life-course
of an individual highlights the difficulties
associated with the conduct of this type of
research. As an urban dwelling population
ages and environmental exposures increase
there is the likelihood that the burden of
disease will increase as a result of the
combination of these factors.
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Where to next?
› A life course approach to chronic disease epidemiology
› Temporal ordering of exposure variables and their interactions
Findings from our research (ABBA ARC Linkage Grant)
Our study of ageing Australians reinforces the association between
long-term exposure to environmental stressors such as air pollution
and noise in large cities and developing long-term health
conditions. The analysis at baseline demonstrated that older urban
and city dwellers were more likely to have one or more long-term
health conditions.
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Acknowledgements
› ARC Linkage Grant – Ageing Baby Boomers Australia and linkage
partners
› Dr Leigh Wilson, Dr Kate O’Loughlin, Professor Hal Kendig
› NCCARF
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